title: [Selective adsorption of endotoxin in the complex treatment of patients with severe sepsis].
abstract: Severe sepsis and septic shock remain the most serious problem of critical care medicine today with a mortality of 25-80%. Bacterial endotoxin is of considerable importance in the pathogenesis of sepsis. A selective hemosorbent in which endotoxin adsorption is accomplished via its binding to a synthetic peptide (LPS-A) has been recently designed in Sweden. The purpose of the study was to evaluate the efficiency of using the LPS-A in the complex treatment of patients with severe sepsis. Eight patients in whom the course of the underlying disease was complicated by the development of gram-negative sepsis in the postoperative period were examined. The patients had an APACHE II score of 20.4 +/- 4.5 LPS-A was performed using the hemosorbent Alteco LPS (Lund, Sweden) and an Aquarius hemoprocessor (Edwards Lifesciences) (U.S.A.). The use of LPS-A caused a significant reduction in endotoxin levels by 2.9 times. The level of procalcitonin was increased in all patients; after a LPS-A session, it was significantly decreased by 1.9 times. The use of LPS-A resulted in diminished tachycardia, elevated blood pressure and could reduce the doses of vasopressor amines. There was an improvement in lung gas exchange parameters. A study of the effect of LPS-A on the immune system showed a significant reduction (36.6%) in neutrophil oxygen-dependent metabolism according to the data of the spontaneous HCT test, a 2.4-fold decrease in large circulating immune complexes, and a rise in the count of mononuclear cells that died both by necrosis and apoptosis, the count of the cells significantly increased by 5.3 times in late apoptosis. A LPS-A session caused a significant drop in the blood level of endotoxin and procalcitonin and it was accompanied by a trend toward better hemodynamics and lung gas exchange and alleviated organ dysfunction. At the same time LPS-A showed the ambiguous effect on immune system parameters, which calls for further study.
authors.forename: M Sh
authors.initials: MSh
authors.lastname: Khubutiia
authors.forename: M M
authors.initials: MM
authors.lastname: Abakumov
authors.forename: I V
authors.initials: IV
authors.lastname: Aleksandrova
authors.forename: S I
authors.initials: SI
authors.lastname: Reĭ
authors.forename: M E
authors.initials: ME
authors.lastname: Il'inskiĭ
authors.forename: V B
authors.initials: VB
authors.lastname: Khvatov
authors.forename: N V
authors.initials: NV
authors.lastname: Borovkova
authors.forename: A S
authors.initials: AS
authors.lastname: Pertsev
authors.forename: V Iu
authors.initials: VIu
authors.lastname: Zinkin
mesh_terms: D018806:APACHE; D000327:Adsorption; D000328:Adult; D017209:Apoptosis; D003131:Combined Modality Therapy; D004731:Endotoxins / Q000097:blood*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000209:etiology / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D006464:Hemoperfusion / Q000379:methods*; D006706:Homeostasis; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000473:pathology; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D004731:Endotoxins